By submitting a question to VascularDoc and selecting “I agree”, I am stating that I agree that all answers from VascularDoc are written in general terms and that this information should be used only as background material for discussions with my own physicians and surgeons. I agree that answers written by VascularDoc are not opinions about my condition or treatment and should never replace consultation with my own physicians. By selecting "I Agree" below, I am also stating that I agree that my question may be used as a source of information and education for other readers. I understand that none of my personal information (including my e-mail address) will ever be published or shared with any other party.

Firstly I would like to thank you guys for such wonderful information and the thread of comments. My mother in law is recently diagnosed with a 90% blockage in her right carotid artery. She is 64. She has diabetes and hypertension since last 25 years. She doesn't have any symptoms of strokes or partial blindness so far. She has 1 stent fixed in her heart 2 years ago. There has been another calcification in her aortic valve, that has to be replaced. But this carotid blockage has become an issue now. We are awaiting the decision from doctors. A word over this from you would be highly appreciated. Thanks again.

Answer:

Diabetes is a risk factor for the development of carotid artery stenosis (narrowing) due to accumulation of atherosclerotic plaque. The ACAS (Asymptomatic Carotid Atherosclerosis Study) published in 1995, showed a significant reduction in the incidence of stroke in patients with significant carotid artery stenosis (defined as greater than 70%) who had surgery to remove the plaque, compared to patients who are treated medically with statin drugs and antiplatelet medications. Every patient is different however, and decisions have to made by your mother-in-law’s physicians based upon her overall medical situation including her calcified aortic valve that may require surgery. Generally speaking, if a 64 yo patient is a good candidate for carotid artery surgery, it is my opinion that they should undergo the carotid surgery to prevent a stroke. The risk of a stroke due to an asymptomatic carotid artery blockage of 90%, without surgery, is approximately 3% annually. The risk is cumulative over time however, so that it is 3% for the first year, 15% after five years, etc. Once a significant carotid artery stenosis becomes symptomatic, the stroke risk becomes very high: 30% risk of stroke during the first 6 months after the development of neurological symptoms. My best wishes to your mother-in-law.